At 732 Million, India Tops List on Number of People Without Access to Toilets: Report

In addition to the increased risk of disease, the lack of sanitation facilities also makes women and girls susceptible to harassment.

India, the world’s second-largest country by population, has the highest number of people (732 million) without access to toilets, according to a new report.

The report by WaterAid, titled Out Of Order:The State of the World’s Toilets 2017, further stated that 355 million women and girls lack access to a toilet. If they were to stand in a line, the queue could circle the Earth more than four times

India’s low ranking on the sanitation index is despite the changes brought by the government’s Swachh Bharat (Clean India) Mission. Launched in October 2014, it increased the country’s sanitation coverage from 39% to 65% by November 2017, according to government data. In this period, 52 million household toilets were built in rural India.

The cleanliness campaign has reduced the proportion of people defecating in the open by 40%, meaning more than 100 million people now use toilets, according to the WaterAid report.

India also ranks sixth among the top ten nations working to reduce open defecation and improving access to basic sanitation. The percentage of population without access to at least basic sanitation fell from 78.3% in 2000 to 56% in 2015, according to the report.

Diarrhoeal diseases kill 60,700 Indian children each year

Each year, 60,700 children under five years die from diarrhoeal diseases, the WaterAid report said.

Diarrhoea remains the second leading cause of death in Indian children under five years, killing an estimated 321 children every day in 2015, as IndiaSpendreported on July 29, 2017, based on a World Health Organization factsheet.

Hookworms, which can spread through open defecation, cause diarrhoea, anaemia and weight loss in women, according to the report. These problems are linked to low birth weight and slow child growth – 38% of children in India under five are stunted, according to the National Family Health Survey, 2015-16, (NFHS-4) data.

Indian states with poor access to sanitation report high incidence of diarrhoeal diseases. Uttar Pradesh, Bihar, Madhya Pradesh, Assam and Chhattisgarh had the highest rate of mortality among children under five years of age, higher stunting (low height-for-age) rates and higher prevalence of diarrhoea due to poor sanitation, as IndiaSpendreported on April 26, 2017, based on NFHS-4

The tables above show the top five and bottom five states based on the percentage of households with improved sanitation, according to NFHS-4. States with higher percentage of improved sanitation have lower levels of anaemia among women (both pregnant and non-pregnant). These states also reported fewer cases of diarrhoea than the national average.

For example, Kerala, which had the highest percentage of households with improved sanitation (98.1%) – the national average was 48.4% – also had the lowest prevalence of diarrhoea (3.4%) and the lowest percentage of women with anaemia (22.6%).

Bihar, with only 25% households using improved sanitation, had the highest prevalence of diarrhoea (10.2%) and the highest percentage of anaemic pregnant women (58.3%).